"Over the past 60 years, the United States residency match process and characteristics of medical students applying to the match have changed considerably. Centralized matching of postgraduate training positions was successfully implemented nationwide in 1952.1 At that time, just over 10,000 positions were offered through the match. In the 2013 match cycle, there were almost 50 different specialties that offer PGY-1 positions through the National Residency Matching Program (NRMP) match and a total of 26,392 positions offered.2

In 2006, in response to concerns about physician shortages, the Association of American Medical Colleges (AAMC) recommended an increase in the number of medical student postions.3 There was an overwhelming response among allopathic programs in both new schools (13 have matriculated their first class since 2006) and larger class sizes in established schools, with rosters expanding 15% to 18%.3,4 Meanwhile, osteopathic medical schools have doubled in number from 15 to 30 over the past 20 years.3 Therefore, the overall number of graduating medical students has increased considerably, reaching an all-time high in 2013.5 This has a direct effect on the quantity of medical students seeking any residency position, including otolaryngology.

The otolaryngology match has also undergone several iterations since its beginnings. In late 1977, otolaryngology and ophthalmology specialties officially separated.6 In 2006, the otolaryngology match transitioned from coordination by the San Francisco match (SF match) to become part of the NRMP. This transition altered the timeline of the application process in otolaryngology and potentially affected the applicant pool. Prior to 2006, the interview season for early match was generally from October to December, with the rank list submission deadline in early January. Match notification occurred in mid-January.7 This allowed applicants who did not match to complete a separate application for other specialties, although interview periods often overlapped. Once the NRMP began coordinating the otolaryngology match in 2006, the interview season was delayed to November through January, with the rank list submission deadline at the end of February. Match notification now occurs in mid-March.8

The change from the SF match to the NRMP match occurred as the required general surgery intern year became integrated with otolaryngology residencies, eliminating the need to separately interview for a preliminary general surgery position.9 Since 2006, otolaryngology programs have an integrated intern year, eliminating the need for a separate match. The early timing of the otolaryngology match allowed for applicants who did not match into otolaryngology to apply for a different specialty during the regular match of the same year through the NRMP. Applicants participating in the couples match during the early match likely found it more difficult to coordinate match cities when one partner applied to otolaryngology and the other to a regular match specialty. It is unclear whether the competitive nature or the couples match situation was considered when the match timing was changed.

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"Over the past 16 years, we have seen an increase in the number of US seniors applying to residency. Fortunately, during the same time period, the number of first-year residency positions in all NRMP specialties increased as well. This rate of growth of residency positions appears to be consistent with the recommendation by the Council on Graduate Medical Education, who recommended increasing the number of first-year residents to 27,000 per year by 2015.4 In the same time frame, the number of unfilled NRMP residency positions has decreased by 55.8%. These positions are being filled by non–US seniors since the overall rate of applications and matches increased while the rate of US senior applications and matches stayed constant. Non–US seniors include prior US medical school graduates and IMG. IMG includes both US citizens attending medical school outside the United States and citizens of other countries attending international medical schools. Data suggest that the IMG portion of this group is filling the additional residency positions. In 2002, 18.6% of all NRMP positions were filled by IMG, while in 2013, IMG matched into 24.8% of NRMP positions. Meanwhile, the percentage of NRMP positions filled by prior US graduates has remained stable (between 2% and 3%). The decrease in percentage of unfilled positions is also due to increased IMG matching.

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"The advantages of the otolaryngology conventional match are the elimination of one of the interview processes (since the preliminary general surgery intern year is now included), as well as improved ability for couples to match together."